MEDICARE: MT. ENTERPRISE ISD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1912135260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT. ENTERPRISE ISD

Provider Business Mailing Address
First Line	:	301 NW 3RD ST
Second Line	:
City	:	MT ENTERPRISE
State	:	TX
Zip	:	75681-7406
Country	:	US
Telephone Number	:	903-822-3575
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 NW 3RD ST
Second Line	:
City	:	MT ENTERPRISE
State	:	TX
Zip	:	75681-7406
Country	:	US
Telephone Number	:	903-822-3575
Fax Number	:

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MR. DEAN EVANS
Credential	:
Telephone Number	:	903-822-3575

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	06/25/2009

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